Thank You Dr. Jane Denton for the Denton Modification

     Today is the last day I am practicing Podiatry with Dr. Jane Denton. She says she is around for September some, but nothing is fixed. So, after asking her advice for 38 years and using her brilliant orthotic modification for lateral stability for almost 35 years, I am finally saying thank you publicly. 

     Dr. Denton's modification has improved the stability for thousands of my thankful patients. A patient of mine last week told me that the difference in a good vs great professional is only in subtleties. The Denton modification is subtle, but powerful. It has been the difference in making my orthotic devices, and overall treatment, a success in both pronators and supinators alike. It is a vital part of the Inverted Orthotic Technique for severe pronators, and a crucial element of every orthotic device designed for supinators. I am attaching a video of the orthotic components crucial for supinators, and a photo of the Denton modification.

     So, Dr Jane Denton, I personally, and the world of podiatry, thanks you anytime the Denton modification is applied to an orthotic device. It always makes a difference, sometimes big and sometimes small, but it is always helpful in treating my patients. I will miss you. Rich 

Here is the Denton applied before ground down even with the floor or base of the shoe. 

https://youtu.be/hMhrTmWXfDA

<iframe width="560" height="315" src="https://www.youtube.com/embed/hMhrTmWXfDA" frameborder="0" allow="accelerometer; autoplay; encrypted-media; gyroscope; picture-in-picture" allowfullscreen></iframe>

Inverted Orthotic Technique: Email Questions

Dear Dr. Blake,

sorry for my bad english,

 I'm an Italian podiatrist; I very interested about inverted technique. I have some questions to ask:

- Is it right to think Fettig modification only with inverted technique? and then, is it only used to correct a forefoot valgus associated with rearfoot varus? if no, when and how?

- Denton and Feehery modification are similar, when apply one or the other?

- In your daily treatment, do you often use these modification?

Thanks for your patience!

Dr Blake's response:

     Thank you for the kind email. I am happy to teach you. Please feel free to take the information I give you and ask any more. I will combine with this posting.  My wife and I hopefully will go to Rome next year on vacation. The Fettig Modification is a modification of the Inverted Technique only and used for the many patients with both a pronation tendency and a supination tendency. The Fettig can only be used in forefoot valgus (everted) feet, as it uses the forefoot valgus correction to be an anti-supination instrument. When the inverted technique controls rear foot pronation, the Fettig can grab that lateral column and slow down or stop mid stance to propulsive phase supination. The supination tendency can come from many causes one of which is rear foot varus, another unstable lateral column, or weak peroneals, or chronic ankle sprains, etc. The Denton modification, her sister lives in Rome, is an extrinsic lateral arch fill that wonderfully fills up the lateral arch  and helps block a supination tendency. The Feehery is an intrinsic raising of the cuboid and lateral anterior calcaneus that does the same, but you cut into the cast. Like the Kirby skive laterally, you have to learn when to violate the cast and when not to. I make orthotic devices as a process typically only violating the cast on the second modification when needed. This is the same general principle I typically use for the Kirby skive.
     Let us say that you have a patient with pronation and supination tendencies. They pronate mainly at contact, but due to chronic ankle instability, love to misstep and supinate at times (typically also at contact). For the pronation, you estimate they need a 30 degree inverted correction. For the supination tendency, they have a forefoot valgus/plantar flexed first ray we can use. So, you order a Fettig. You can also typically add a high lateral heel cup and lateral phalange, a Denton modification, and a full topcover to a forefoot valgus extension under the 4th and 5th metatarsal heads. 
     Let us say that you suspect initially, or you see at dispense, that the patient is not as controlled laterally as you would like. Your next orthotic device will be a lateral Kirby skive to the above cast, a Feehery cuboid skive, or both. And you  can also add more height to the lateral heel cup, and more height to the lateral phalange, along with a bigger forefoot valgus forefoot extension. The possibilities are endless. Please ask other questions. Rich

PS I use the Denton routinely (almost daily) and the Fettig modification 1-2 times per year. I probably use the Feehery once every other month. I relie a lot on stable shoes, lateral phalanges, forefoot valgus extensions.